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Ultrafast MR Imaging of the Pelvic Floor

M. Unterweger1, B. Marincek1, N. Gottstein-Aalame1, J. F. Debatin1,2, B. Seifert3, N. Ochsenbein-Imhof4, D. Perucchini4 and R. A. Kubik-Huch1

1 Institute of Diagnostic Radiology, University Hospital, Rämistr. 100, CH-8091 Zurich, Switzerland.
2 Present address: Department of Diagnostic Radiology, University Hospital Essen, Hufelandstr. 55, D-451222 Essen, Germany.
3 Department of Biostatistics, University of Zurich, CH-8006 Zurich, Switzerland.
4 Department of Gynecology and Obstetrics, University Hospital, CH-8091 Zurich, Switzerland.



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  		Fig. 1. —Axial T2-weighted fast spin-echo image of 31-year-old nulliparous woman shows lines drawn on workstation for left and right vaginal-angle measurements. Note H-shaped vagina and symmetric levator muscle.

 


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  		Fig. 2. —Axial T2-weighted fast spin-echo MR image of 36-year-old woman with stress urinary incontinence shows flattened vagina (arrow) at level of pubic symphysis. Levator ani could not be followed to pubic symphysis on right side.

 


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  		Fig. 3A —32-year-old nulliparous woman. Axial T2-weighted fast spin-echo MR images at pubic symphysis, frequency direction right to left (A) and anteroposterior (B), show thinner levator muscle on right (arrow) than on left, independent of frequency direction.

 


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  		Fig. 3B —32-year-old nulliparous woman. Axial T2-weighted fast spin-echo MR images at pubic symphysis, frequency direction right to left (A) and anteroposterior (B), show thinner levator muscle on right (arrow) than on left, independent of frequency direction.

 


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  		Fig. 4. —Box plots of distances between bladder floor and pubococcygeal line at rest and on straining for the four different groups (N, nulliparous; V, vaginal delivery; S, cesarean delivery; P, stress incontinence). Box lines represent 25%, 50%, and 75%; whiskers represent 10% and 90%; and circles indicate maximal and minimal bladder volumes.

 


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  		Fig. 5. —Dynamic sagittal T2-weighted MR images in 32-year-old nulliparous woman at rest (left image) and on maximal straining (right image), show no significant pelvic floor descent. Pubococcygeal line (1) and distances to bladder floor (2) and cervix (3) are also shown.

 


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  		Fig. 6. —Dynamic sagittal T2-weighted MR images in 37-year-old woman with history of vaginal delivery at rest (left image) and on maximal straining (right image) show some bladder floor descent on straining. Uterus is retroverted.

 


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  		Fig. 7. —Dynamic sagittal T2-weighted MR images in 38-year-old woman with stress incontinence show significant pelvic floor descent at rest (left image) and on maximal straining (right image).

 

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